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Published on: September 30, 2021
Individualized HCC surveillance using risk stratification scores in advanced fibrosis and cirrhotic HCV patients who
Gamal Shiha1,2, Ayman Hassan2,3, Nasser Mousa4
1Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Insights
This study prospectively validated HCC risk scores for advanced liver disease patients achieving sustained viral response after direct-acting antiviral therapy. Individualized risk stratification improved early hepatocellular carcinoma detection and curative treatment rates.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Prospective validation of existing hepatocellular carcinoma (HCC) risk stratification scores is lacking.
- Direct-acting antiviral (DAA) therapy achieves sustained viral response (SVR) in chronic hepatitis C (HCV) patients.
- Advanced liver disease (F3-F4 fibrosis) requires effective HCC surveillance.
Purpose of the Study:
- To prospectively validate six HCC risk scores in F3-F4 patients with SVR post-DAAs.
- To assess if individualized risk stratification enhances early HCC detection and curative treatment.
Main Methods:
- Two prospective cohorts (ELRIAH: 463 patients, Tanta: 492 patients) with F3-F4 chronic HCV and SVR.
- Standard surveillance (every 6 months) vs. individualized surveillance based on HCC risk scores (GES score).
- Evaluation of six HCC risk scores for patient stratification.
Main Results:
- Most scores (except Watanabe) effectively stratified patients (log-rank p=0.001, Harrell's C=0.669-0.728).
- GES score identified the highest proportion of low-risk patients (42.5%).
- The individualized surveillance cohort showed higher rates of early-stage HCC diagnosis (BCLC 0/A: 80% vs. 52%).
Conclusions:
- Prospective validation confirmed the utility of several HCC risk scores.
- Individualized risk stratification improved early HCC detection and access to curative therapies.
Background:
Several HCC risk stratification scores were developed; however, none has been prospectively validated. The primary aim is to validate the clinical utility of six HCC risk scores in large prospective study of F3-4 patients achieving SVR following DAAs according to EASL guidelines. The secondary aim is to explore whether individualized risk stratification improves detection of HCC at early stages amenable to curative treatment.
Methods:
This prospective study included two cohorts: Egyptian Liver Research Institute and Hospital (ELRIAH) cohort of 463 chronic HCV patients with advanced liver disease (F3 and F4) achieved SVR with a follow-up every 6 months according to EASL guidelines using 6 simple HCC risk scores and Tanta cohort of 492 comparable patients where individualized surveillance intervals were tailored based on HCC risk assessments using GES score as follows: low-risk patients were followed yearly, intermediate-risk every 6 months and high-risk every 2-3 months.
Results:
All scores, except Watanabe post, successfully stratified patients into low-, intermediate- and high-risk groups, with log-rank p-value of 0.001 and Harrell's C ranging from 0.669 to 0.728. Clinical utility of these scores revealed that the highest percentage of patients classified as low risk was 42.5% using the GES, while the lowest was 8.9% using the aMAP. ELRIAH cohort, 25 patients developed HCC with 52% diagnosed at BCLC 0 and A. Tanta cohort, 35 patients developed HCC, with 80% diagnosed at BCLC 0 and A.
Conclusion:
Individualized risk stratification using HCC risk scores was associated with improved early-stage detection and receipt of curative treatment.
